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Periodontal Disease- is a group of diseases that affect the tissues that support and anchor the teeth. If untreated, periodontal disease results in the destruction of the gums, alveolar bone (the part of the jaws where the teeth arise), and the outer layer of the tooth root. The earliest form of periodontal disease is called gingivitis. Gingivitis is reversible with proper treatment.

Once a patient is diagnosed with advanced periodontal disease (also called periodontitis), their dentist will recommend procedures above and beyond that of a normal professional cleaning to properly treat and manage the periodontal disease. In the initial stages, most treatment revolves around non surgical intervention but as the periodontal disease progresses surgical treatment is often recommended and required.

Periodontal Disease Treatment

Non Surgical Procedures

-Scaling and root planing. This procedure is a special type of cleaning that removes plaque and tartar from under the gum line and makes the root surfaces smooth. The smoother root surface is thought to promote reattachment of the gum tissue and promote healing. This type of cleaning is the only way to remove tartar from below the gum line. This is usually completed in multiple visits utilizing a numbing anesthetic to make the procedure more comfortable..

-Drug Therapy. In some cases, antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early periodontal disease, scaling and root planing in addition to continued daily cleaning at home (flossing, brushing , and rinsing) will achieve a satisfactory result of reversing periodontal disease.  A wide array of antibacterial rinses such as Peridex, antibiotics taken in pill form such as  Periostat, or localized placement directly into the affected pockets with an antibiotic such as Arestin, can aide in, and promote healing of the affected gum tissue.

-Periodontal maintenance or supportive periodontal therapy: Following a scaling and root planing, routine specialized  cleanings (every 3-4 months)  to target your periodontal problem area, can minimize the recurrence or progression of periodontal disease.

Surgical Procedures

-Pocket depth reduction procedures: Your dentist or periodontist will open up the affected gum tissue so that periodontal disease causing bacteria and calculus build up can be easily seen and removed. Some cases may require contouring and smoothing of the damaged bone and root surfaces to allow the gum tissue to reattach to healthy bone during the healing phase. The procedure also repositions the gum tissue so that it is easier to keep clean going forward.

-Perioscope cleaning: A deep cleaning requiring a microscope to be placed below the gum line to remove tartar, cement, or other debris.

-Regeneration. Your dentist will treat the affected gum tissue in the same way as in pocket depth reduction procedures, with the additional procedure of using membranes, bone grafts or tissue-stimulating proteins to stimulate the body’s natural ability to regenerate healthy bone and gum tissue. A good example of this is a bone and tissue growth factor called Emdogain.

-Soft tissue grafts. Your dentist will take synthetic tissue such as Alloderm, or healthy gum tissue from the roof of the mouth (palate) or other areas of the mouth and use it to repair receding gums and cover exposed root surfaces.

-Hard Tissue Bone Grafts.  This procedure is needed when periodontal disease has destroyed the bone surrounding your tooth. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone. The dentist can use your bone, cadaver bone, cow bone, or a lab created calcium based bone matrix material.

Conclusion

If you have been diagnosed with periodontal disease please take the news very seriously. Periodontal disease is a progressive disease that will continue to get worse without treatment. Periodontal disease  leads to tooth loss and oral infections. Your dentist can help you with diagnosis, prevention, better oral hygiene methods and instruction, and proper treatment for your particular needs.  Studies have shown time and again that there is a link between oral health and your general health. Keeping your mouth healthy will lead to better overall health. As always visit your dentist regularly for dental examinations and regular professional cleanings to stave off the onset of periodontal disease.

Periodontal Disease – is a progressive inflammatory disease, that affects the tissues that support and anchor the teeth. These support tissues include, gums, bone, cementum, and ligament attachments.

The main area in which periodontal disease is diagnosed and treated is in “the pocket”. The pocket is the unattached tissue between the tooth and gum, measured with a tiny ruler-like instrument called a periodontal probe. A healthy tooth generally has pocket measurements of 0-3 mm, whereas diseased tissue can be 4-15 mm deep, ( The deeper the pocket, the more difficult to fully clean). The measurements vary in what they measure, for example, in Gingivitis measurements indicate how swollen the tissue is, while in Periodontitis, the measurements indicate the loss of bone and gum tissue. If  left untreated, periodontal disease results in the destruction of the support structure, bacteria growth down into pockets, toxin release (to breakdown attachments),  loosening of teeth, and subsequent tooth loss.

Stages of Periodontal Disease

Periodontal disease is said to affect over 50% of all Americans. Periodontal disease advances in 4 stages:

1. Gingivitis- Swollen, red, inflamed gum tissue. There has not been loss of attachment at this stage. Reversible with proper hygiene.

2. Early Periodontitis- Less than 25% attachment loss, as determined by x-ray and measurement with a probe.

3. Moderate Periodontitis-25-50% attachment loss as determined above.

4. Advanced Periodontitis-50% or more attachment loss.

Periogen Marielaina Perrone DDS

Periogen Used to Fight Tartar

Periodontal disease can be reversible in its earliest form. This form of periodontal disease is called gingivitis. But if the periodontal disease progresses to periodontitis then the damage is not reversible by the body on its own. Patients and dentists alike are always looking for ways to combat periodontal disease with newer and better ways to treat the disease and maintain good oral hygiene at home. The tried and true home methods have generally consisted of varying types and techniques with  tooth brushing, flossing, and antibacterial rinses. All of these methods have the same limiting factor, none of the at home methods could target the deeper pockets of 5 mm and above, until a new product was formulated in conjunction with the waterpik utilizing a special tip which places a tartar dissolving liquid  directly where it is needed. This new rinse is called Periogen.

What Does Periogen Do to Fight Against Periodontal Disease?

Periogen is a patented oral rinse that has been proven capable of dissolving tartar buildup between professional cleanings and dentist visits. Periogen works by exploiting a weakness (discovered by the research team at the Periogen Company) in the fundamental structure  of oral tartar, and its adhesive nature.

Tartar (or calculus as it is sometimes called) can be found above and below the gum line. Tartar above the gum line is referred to as supra gingival tartar and tartar below the gum line is referred to as sub gingival tartar. Dental Tartar is comprised almost entirely of Calcium Phosphate Salt. Calcium Phosphate is the basic component of tooth material. Calcium phosphate salt differs from calcium phosphate in its electron structure. The calcium phosphate salt has two less electrons than the calcium phosphate which makes it electrically unstable. This process of losing electrons happens in nature all the time. The best comparison is the buildup of lime deposits in water pipes and faucets. Microscopically, tartar is layer upon layer (can be in the tens of thousands layers) of fossilized bacteria trapped between the calcium salts.

The tartar causes periodontal disease by toxins released by the bacteria in plaque and tartar on teeth. The toxins cause the body to react by starting the inflammatory

Periogen Marielaina Perrone DDS

Periogen Oral rinse for Dissolving Tartar Between Professional Cleanings

process thereby destroying healthy gum tissue and supporting bone structures. Periodontal disease is progressive and without periodontal disease treatment will lead to tooth loss and infections throughout the mouth.

Periogen is used as an oral rinse 1-2 times per day between professional cleanings to reduce the level of tartar buildup and stain. This will in turn make for an easier dental visit but also maintain a healthier state in your mouth for your teeth and gums to heal. Periogen should in no way replace brushing and flossing, or visits to the dentist but just works as an accessory between professional dental cleanings to give you a more effective way to reduce tartar and fight periodontal disease .

Periogen Conclusion

As you know, there are many methods and products on the market to aide you in your dental hygiene and combat periodontal disease. Remember this, “The best  offense is a good defense!”.   It is up to you to find and decide what works best for you to prevent periodontal disease. Visit your dentist regularly for dental examinations and professional cleanings to ward off dental problems and stay healthy.

 

Periodontal diseaseis an infection of the gums, attachments and bone that surround and support the teeth. In its early stage, called gingivitis, the gums can become swollen and red, and they may bleed. In its more serious form (called periodontitis) the gums can pull away from the tooth and bone can be lost, and the teeth may loosen or even fall out. Periodontal disease is mostly seen in adults. Periodontal disease and tooth decay are the two biggest threats to dental health.

What is MyPerioPath?
What does it have to do with Periodontal Disease?

MyPerioPath is a diagnostic tool that identifies the type of bacteria and the concentration of the bacteria present in the saliva.  Dentists and researchers have long known the specific bacteria known to cause periodontal disease so this tool gives us an idea of where each patient is and how to treat them. This makes periodontal disease treatment more personalized and allows for more predictable outcomes.

Bacteria Associated with Periodontal Disease

Researchers have discovered over 350 different species of microorganisms in the typical person’s healthy mouth. Less than 5% of these microorganism species are linked to periodontal diseaseinfections. Research

MyPerioPath Marielaina Perrone DDS

MyPerioPath Kit for Periodontal Disease Treatment

has also shown that these ” bad bacteria”, can be shared with your partner. So, if you , or your partner has progressive periodontal disease, you may both need to be checked and or treated with antibiotics.

Healthy and disease causing bacteria are usually grouped into two distinct categories:

1) Gram positive aerobic bacteria. These are harmless or helpful bacteria in the mouth.

2) Gram negative anaerobic bacteria. These are bacteria related to periodontal disease. When periodontal disease develops, the bacterial balance shifts over to these types of bacteria. Inflammation and injury cannot develop without these bacteria flourishing in the mouth.

Some of the bacteria most implicated in periodontal disease and bone loss include:

-Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. These two bacteria appear to be particularly likely to cause aggressive periodontal disease. Both P. gingivalis and A. actinomycetemcomitans, along with multiple deep pockets in the gum, are associated with resistance to standard treatments for gum disease. P. gingivalis may double the risk for serious gum disease. P. gingivalis produces enzymes, such as one called arginine-specific cysteine proteinase, that may disrupt the immune system and lead to subsequent periodontal connective tissue destruction.

-Bacteroides forsythus is also strongly linked to periodontal disease.

Other bacteria associated with periodontal disease are Treponema denticola, T. socranskii, and P. intermedia. These bacteria, together with P. gingivalis, are frequently present at the same sites, and are associated with deep periodontal pockets.

Some bacteria are related to gingivitis, but not plaque development. They include various streptococcal species.

How does MyPerioPath help personalize Periodontal Disease Treatment?

By knowing the exact bacteria and concentrations of each we are able to set up a treatment plan aimed at those specific bacteria. This can include the following treatment:

MyPerioPath Marielaina Perrone DDS

MyPerioPath Sample Results

-Oral hygiene Instruction. Any dental treatment is doomed to fail without oral hygiene maintenance at home. Periodontal disease is progressive and will get worse without proper treatment and maintenance.

-Scaling and Root Planing. This treatment is also referred to as a deep cleaning. The goal of initial periodontal disease treatment is to remove the plaque and tartar buildup as well as to disinfect the mouth to lower the progress of periodontal disease. The removal of deep plaque and tartar, and smoothing of the root surface allows for healing and reattachment. This leads to healing and hopefully, reduced pocket depth.

-Periogen. Oral rinse for dissolving tartar buildup between professional cleanings. This oral rinse can lower the inflammatory process by removing some of the tartar and bacterial buildup in the mouth.

- Antibiotics. The test really shines in allowing the dentist to tailor a specific antibiotic regimen for each patient. The antibiotic used may be different for each patient depending on their bacteria types and levels. The antibiotic treatment will allow the bacteria levels to decrease dramatically thus halting the progress of the periodontal disease.

Other Tests Available for Periodontal Disease

There is another test available for testing periodontal disease called MyPerioID PST. Salivary DNA test that determines increased risk for severe periodontal infections. The MyPerioID PST test identifies individual genetic susceptibility to periodontal disease and allows the dentist to establish which patients are at increased risk for more severe periodontal infections due to an exaggerated immune response.

MyPerioPath Conclusion

Is this periodontal disease test necessary for everyone? Probably not. It does come at a cost so it should only be utilized where necessary. For some patients, normal periodontal disease treatment is not enough and this test could help stave off periodontal disease progression and aide in more successful healing. Keeping regular dental visits as well as regular professional cleanings coupled with a good oral hygiene regimen at home is the perfect recipe for staving off periodontal disease.

 

The ultimate goal of periodontal disease treatment is to allow for re formation of and re attachment of the tissues. The best way (and least invasive) is via regeneration(regrowth). There have been many products over the years that have been considered the next big thing in regenerative therapy. Very few have ever seen the results of emdogain. Emdogain is made up of various biological proteins and growth factors that have been scientifically proven (thru research and trials) to regrow gum tissue,connective tissue and bone. Emdogain has been shown stable and predictable Periodontal  regeneration of lost periodontal tissues.

How Does It Work?

Emdogain achieves its results by tricking the body into forming new bone, cementum, and attachment fibers. The emdogain’s secret weapon is in its enamel matrix proteins (also called amelogenins) taken from developing teeth in pigs. Humans do not recognize these proteins as foreign, as they are similarly found in all mammals. There is also a zero chance of transmission of any disease by the proteins. During tooth development these proteins are secreted onto the root surface that is developing preceding the formation of tooth attachment. Luckily for us, this also occurs when the proteins are placed on the root surface of a tooth that has lost bone and attachment from periodontal disease.

Periodontal regeneration

Emdogain

By reintroducing enamel matrix proteins, you are triggering a biologic response from the body to do what it did naturally during your earliest of development. Enamel matrix proteins are only in the body for a short window of time during human development.When applied to the root surface of teeth, these proteins group and form into an insoluble matrix layer that promotes the attachment of mesenchymal cells. These cells produce new matrix components and growth factors that participate in the regain of tooth attachment. Epithelial cell growth is also inhibited by emdogain. This allows for proper tissue and bone reformation to take place without interference.

Treatment

Periodontal regeneration

Radiograph showing bone level before and after emdogain.

Once your dentist has diagnosed, the presence of periodontal disease. Emdogain will be discussed as the least invasive and most effective way to restore the area back to its natural cosmetic appearance. The area in question is generally referred to as a defect. That term is used because there is a periodontal pocket present where the bone and soft tissue has moved away from attaching to the tooth. This is caused by the periodontal disease process. After the defect has been  exposed so the dentist has full visualization of the area. The area is cleaned and debrided of any inflamed, diseased tissue or hard tartar deposits. Emdogain is used to help the tissues repair themselves. Emdogain comes as a premixed gel in a syringe. The material is inserted into the defect area. The area is closed and patient can then go about their normal lives. Obviously, the area might be a little tender and patient should avoid flossing and chewing on that side for a few days to allow proper healing time and no disturbance of emdogain as it does its work.

Post Treatment

In the following two weeks, approximately 75% of the tooth surface where the defect was present will be covered withPeriodontal Regneration the newly developing tooth tissues. The attachment and supporting  structures begin to reattach to the tooth to aid in keeping the tooth stable and healthy. These new tissues will take about one year to complete the maturation process. For this reason, the area where Emodgain is used, should not be periodontally probed (by your dentist or hygienist) for a period of about 6 months. Emdogain can also be used with soft tissue defects.

Emdogain is not ideal for every defect. Your dentist will be able to describe to you if emdogain is right for your particular case.